Congestive Heart Failure

CONGESTIVE
HEART FAILURE
DEFINITION
• Definition: Failure of cardiac output to meet
metabolic needs of the body
• Cardiac Failure results in inadequate oxygen

delivery to body tissues
• Compensated Heart Failure: compensatory

mechanisms increase the cardiac output and the
oxygen delivery
• Decompensated Heart Failure: compensatory

mechanisms start failing and cardiac output starts
falling
CARDIAC OUTPUT
• Cardiac Output = Heart Rate X Stroke Volume
• Stroke volume is dependent on three factors:
• Preload – (blood volume overload, End Diastolic Volume)
• Afterload – resistance (pressure) against which the heart must pump blood, systemic vascular resistance
• Contractility of heart – Cardiac Performance
Normal cardiac output in neonates 150 to 300 mL/kg/min

FACTORS AFFECTING CARDIAC
PERFORMANCE
• Cardiac output depends on: stroke volume and heart rate.
• Stroke volume is dependent on three important factors:

Preload,
1. Afterload and
2. Contractility.
• Preload = volume of blood received
by the heart.
Basically, preload is stretch.
• Afterload = pressure or resistance the

heart has to overcome to eject blood.
• Afterload is squeeze.
CLINICAL ASSESSMENT OF SEVERITY IN
CHILDREN
MODIFIED ROSS HEART FAILURE
CLASSIFICATION IN CHILDREN
CLASS INFANT CHILD
Asymptotic Asymptotic
I
No limitations No limitations.
Mild Tachypnea or diaphoresis with
II feeding Dyspnoea on exertion
No growth failure
Marked Tachypnea or diaphoresis

with feeding Marked dyspnoea on exertion
III
Prolonged feeding times FTT
FTT
Tachypnea, retractions, grunting, or Tachypnea, retractions, grunting, or

IV
diaphoresis at rest diaphoresis at rest
CLASSIFICATION OF HEART
FAILURE
(1) According to the course of disease
1) Acute HF
2) Chronic HF
2)According to the cardiac output (CO)
1) Low-output HF: due to volume overload, pressure overload & contractility problems.
2) High-output HF: Heart Rate is primarily affected; 3A(Anemia, Arrhythmia, AV Fistula)

CLASSIFICATION OF HEART
FAILURE
(3) According to the location of heart failure
1) Left –side heart failure (LHF)
2) Right-side heart failure (RHF)
3) Biventricular failure (whole heart failure)
(4)According to the function impaired CARDIAC TAMPONADE. A SERIOUS CARDIAC CONDITION

WHERE BLOOD, FLUID, OR AIR FILL THE PERICARDIAL
SAC THAT ENCASES THE HEART CAUSES EXTREME
COMPRESSION OF ALL FOUR CHAMBERS OF THE HEART
1) systolic failure : Myocarditis, hypertension TROUBLE PUMPING BLOOD TO MAJOR ORGANS!
CLASSIFICATION OF HEART FAILURE
2) Diastolic failure: restrictive cardiomyopathy, cardiac tamponade.

ETIOLOGY
• Congenital Heart Disease – VSD, ASD, PDA
• Rheumatic Fever, Rheumatic Heart Disease –
MR
• Cardiac Arrhythmia – SVT, VT
• Severe anemia
• Pericardial effusion
• Hypertension – Renal diseases (Acute
glomerulonephritis, CKD)
• Pulmonary hypertension (cor-pulmonale)
• Cardiomyopathy
SYMPTOMS
• Infants:
• Feeding problems,
sweating
• Oliguria
• Growth failure
• Older children:
• Exertional dyspnea
• Fatigue
• Edema
• Palpitation
• Pain abdomen
TIC
EVALUAT
• X-ray Chest (cardiomegaly)
ION
• ECG – (ventricle hypertrophy)
• Echocardiography –
Low Ejection Fraction (N = 55-65%)
• Oxygen saturation (Pulse oximetry)

– low in pulmonary edema
OTHER INVESTIGATIONS
• CBC
• Electrolytes
• Cardiac Biomarkers – increase in ventricular dilation(for heart
damage or stress due to low oxygen)
Brain natriuretic peptide (BNP) – more than 100 pg/mL
N-terminal prohormone BNP (NT-pro BNP)(to check intravascular

blood volume and vascular tone)
• Liver Function Tests
• Renal Function Tests
COMPLICATIONS
• Cardiac • Liver dysfunction
Arrhythmia
• Renal failure
• Thrombo- • Electrolyte
embolism Imbalance
• Failure to thrive –
• Repeated chest
low weight and
infections
height
• Pulmonary edema
MANAGEMENT
• Diuretics eg. Furosemide
• Digoxin
• ACE inhibitors (ACEI, ARB) eg.:- Captopril, Enalapril.
• Neprilysin inhibitors (Sacubitril-valsartan)
• Beta-blockers (metoprolol, and propranolol)
• Treat the cause of Heart Failure

Congestive Heart Failure

Uploaded by

Copyright:

Available Formats

Congestive Heart Failure

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Congestive Heart Failure

Uploaded by

Copyright:

Available Formats

CONGESTIVE

• Cardiac Failure results in inadequate oxygen

• Compensated Heart Failure: compensatory

• Decompensated Heart Failure: compensatory

• Stroke volume is dependent on three factors:

• Preload – (blood volume overload, End Diastolic Volume)

• Contractility of heart – Cardiac Performance

Normal cardiac output in neonates 150 to 300 mL/kg/min

• Stroke volume is dependent on three important factors:

Basically, preload is stretch.

• Afterload = pressure or resistance the

Marked Tachypnea or diaphoresis

Tachypnea, retractions, grunting, or Tachypnea, retractions, grunting, or

2)According to the cardiac output (CO)

2) High-output HF: Heart Rate is primarily affected; 3A(Anemia, Arrhythmia, AV Fistula)

1) Left –side heart failure (LHF)

2) Right-side heart failure (RHF)

3) Biventricular failure (whole heart failure)

(4)According to the function impaired CARDIAC TAMPONADE. A SERIOUS CARDIAC CONDITION

2) Diastolic failure: restrictive cardiomyopathy, cardiac tamponade.

• Oxygen saturation (Pulse oximetry)

N-terminal prohormone BNP (NT-pro BNP)(to check intravascular

• ACE inhibitors (ACEI, ARB) eg.:- Captopril, Enalapril.

• Neprilysin inhibitors (Sacubitril-valsartan)

• Beta-blockers (metoprolol, and propranolol)

• Treat the cause of Heart Failure

You might also like